Mail to: North Carolina A&T State University
Office of Extended Learning - Summer Sessions
1020 E Wendover, Suite 101
Greensboro, North Carolina 27405
Phone: (336) 334-7810 Fax: (336) 334-7081
admitted to A&T or Post Baccalaureate Studies (PBS). Please contact either the Undergraduate Admissions Office or The Graduate College.
TODAY DATE: _________________________________
Session(s):
Check all that applies: Dual Session
Admission Status:
Student Athlete Other Specify
Legal Name:
Last
First
MI
Other
Current Mailing Address:
Apt. # State Zip
Telephone Number: (Daytime) ( ) Telephone Number: (Evening) ( )
Email Address:
Telephone Number ( )
Full Name
Address: (if different from above)
Street Apt# City State Zip
Date of Birth:
Mo Day Year City State/County
(please attach photocopy of your VISA)
Sex: Male
Female White Other
Education:
Have you applied for admission to NC A&T? No Yes When?
Have you ever been admitted to NC A&T? No Yes When?
Have you ever been enrolled in classes at NC A&T? No Yes When?
Are you currently enrolled in any academic institution? No Yes When?
(If you answered 'yes,' complete the section below)
City/State Dates Attended
High School:
College/Undergraduate:
College/Graduate
Education Completed: High School Associate's
*Master's
Residency Information
Your residency for tuition purposes determines your in-state or out-of-state status and may impact your admission, tuition, scholarship or financial aid
eligibility. North Carolina residency for tuition purposes is governed by North Carolina state law. More information about North Carolina residency for
tuition purposes can be found at www.ncresidency.org.
Do you claim to be a North Carolina Resident?
Residency Certification Number (RCN) _____________________
Yes I claim to be a North Carolina resident for tuition purposes. *
No I do not claim to be a North Carolina resident for tuition purposes. I understand I will be charged the non-resident tuition rate if
enrolled at a North Carolina state-supported institution.
*If you claim to be a resident, you must complete the residency process with the Residency Determination Service (RDS) at www.ncresidency.org. You will receive a
Residency Certification Number (RCN) which should either be entered onto you admissions application or provided directly to Office of Extended Learning - Summer Sessions,
when available.
Revised 8/2018
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Emergency Contact
Relationship
North Carolina Agricultural and Technical State University
(PLEASE COMPLETE ALL SECTIONS AND SIGN)
ADMISSION APPLICATION FOR VISITING / NON-DEGREE SEEKING STUDENTS
Application will NOT be processed without the $45 application fee.
The nonrefundable fee may be paid by personal check, money order or cashier's check payable to: North Carolina A&T State University
This form is NOT an application for admission to the University and IS NOT intended for use by continuing NC A&T degree students/candidates already
Pre-Session
1st Session
2nd Session
Intersession
Visiting Undergraduate
Distance Learning
High School Student
In-coming Freshman
Spring
Non-Degree Seeking
Street
City
Citizenship: US
Ethnic Group: American Indian
Place of Birth:
County of Residence:
* Doctoral
Currently
Nonresident Alien
Resident Alien
Country of Citizenship:
If citizenship other than US, indicate VISA status:
Name of School
* Please submit your application to: The Graduate College - 120 Gibbs Hall - Greensboro, NC 27411
Black (Non Hispanic)
Asian or Pacific Islander
Hispanic
(For reporting purposes only )
*Bachelor's
NOTE: 1. Download forms to your desk top.
2. Complete and save form
3. Email to osso@ncat.edu or fax to 336-334-7081.
If you answered “yes” to any of the six questions above, please explain the circumstances below. Attach a second sheet if necessary.
______________________________________________________
Applicant Signature
Eligiblity Requirements:
1. Return home to permanent residence in Guilford County for the summer.
2. Enrolled in a University outside of Guilford County during current spring semester
3. Submit Waiver by checking box: Yes requesting Waiver
IF ADDITIONAL INFORMATION IS NEEDED, THE APPLICANT WILL BE NOTIFIED.
Website (NCAT) Brochure/Flyer Newspaper
Friend/Family
Radio/Television Email/Letter Social Media
Other _________________
By signing this application, I agree to abide by the policies and regulations of North Carolina A&T State University and to the best of my knowledge, the information I have given is
true. I understand that any misrepresentation of facts on this application will be cause for refusal of admission, cancellation of admission, or suspension from the University.
Your "yes" answer to one or more of the following questions will not necessarily preclude your being admitted. However, your failure to provide complete,
accurate and truthful information will be grounds to deny or withdraw your admission, or to dismiss you after enrollment. For the purpose of the following six
questions, “crime” or criminal charge” refers to any crime other than a traffic-related misdemeanor or an infraction. You must, however, include alcohol or drug
offenses whether or not they are traffic related.
HOME FOR THE SUMMER - FEE WAIVER
(Limited to the first 50 Validated Students)
Campus Safety Questions:
You must promptly notify the Admissions Office in writing of any criminal charge, any disposition of a criminal charge, or any school, college, or university
To help better serve you, we need to know how did you hear about us. Please check all that apply:
Page 2 of 3
Signature Date
disciplinary action against you, or any type of military discharge other than an honorable discharge that occurs at any time after you submit this application.
Your failure to do so will be grounds to deny or withdraw your admission, or to dismiss you after enrollment.
1) Have you been convicted of a crime? ( Yes ) No
2) Have you ever entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea, or have you received a
deferred prosecution or prayer for judgement continued, to a criminal charge? (
Yes ) No
3) Have you otherwise accepted responsibility for the commission of a crime? Yes No
4) Do you have any criminal charges pending against you? ( Yes No
5) Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any
school, college, or university? Yes No
6) If you have ever served in the military, did you receive any type of discharge other than an honorable discharge? ) Yes ) No
( ) Currently Serving ( Never Served
N.C. A&T does not discriminate against employees, students, or applicants on the basis of age, color, disability, gender, gender identity, gender expression, national
origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law.
Thank you for applying to North Carolina A&T for your summer classes. You may submit your application and make your payment online here. We will
register you in the classes once your application is processed and we have received the signed course request form located below.
click to sign
signature
click to edit
click to sign
signature
click to edit
NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
Approval for Admission
As a Non-Degree/Visiting Student
To Be Completed by the Student:
Students admitted as transient (visiting) students are required to submit this form with
the summer sessions
application. Print your name, ID#, and address (Permanent and Local) below. You must have your appropriate
school/college/university official to complete information below.
Name _______________________________________________________________________________________
Last First Middle
E-Mail: _________________________________________ Contact Number: ____________________
Permanent Address _____________________________________________________________________________
Street City State Zip
Local Address _________________________________________________________________________________
Street City State Zip
Courses Requested: (Click here to view class schedule)
SUBJECT
COURSE
NUMBER
SECTION
COURSE
REF #
(CRN)
CREDIT
HOURS
START-
END
TIME
DAYS
Form Revised 08/18
For Office Use Only
Received: __________________
Processed: _________________
Banner ID:_________________
IMPORTANT NOTICE
North Carolina State Law requires all undergraduate and graduate students to provide documented proof of the required immunizations.
Students will not
be permitted to register without proof of all required vaccines. Please contact the Sebastian Health Center at (336) 334-7880
if you have questions.
Visiting Students Only:
T
his section is to be completed by the School/College/University if courses will be transferred back to home
institution.
The above named student date of attendance is ________________________________. This student is in good
standing at ______________________________________________________ and therefore, has permission to take
courses listed above at North Carolina A&T State University.
Signature of Home Institution Representative: __________________________________________
Contact Telephone Number: _____ ______________________
College/School University: ___________________________________________________ Date: _____________
NOTE: 1. Download forms to your
desk top.
2. Complete and save form
3. Email to osso@ncat.edu or fax to 336-334-7081.
Page 3 of 3
TERM
Spring
Spring
Spring
Spring
Spring
Spring
Spring